Conservative Management of Varus/Valgus Stable Tibial Plateau Fractures in Osteoporotic Bone – Preliminary Results and Considerations

Document Type : RESEARCH PAPER

Authors

1 Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom- Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

2 Department of Trauma and Orthopedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom - School of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom

3 Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, United Kingdom

4 Department of Trauma and Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

Abstract

Objectives: While operative fixation is the current recommendation for treating significantly displaced 
tibial plateau fractures (DTPFs) in elderly patients, our research suggests that non -operative 
management may also be a viable option as the primary treatment for these individuals. Our study 
aimed to evaluate the clinical outcomes of patients with complex DTPFs who received non-operative 
management as their primary management.
Methods: Our study involved a retrospective analysis of non-operatively treated DTPFs during the period of 2019 
to 2020. We included all patients for the evaluation of fracture healing and range of motion (ROM). Additionally, 
we conducted functional outcome assessments on all patients, utilizing the Oxford Knee Score (OKS) both before 
their injury and at the 10-month mark after their injury.
Results: The study included 10 patients, comprising two males and eight females, with a mean age of 62.9 years 
(range: 46-74). Among them, four patients had Schatzker Type III DTPFs, two had Type V, and four had Type VI. 
Non-operative management was administered using hinged-knee braces, and patients progressed to weightbearing gradually, with a minimum follow-up period of 10 months. The average time to bone union was 4.3 months 
(range: 2-7). The mean Oxford Knee Score (OKS) after the injury was 38.8 (range: 23-45), with an average 
reduction of 16.9% (p = 0.003). The average fracture depression was 11.41 mm (range: 4.2-29), and the average 
fracture split was 14.03 mm (range: 5.5-44).
Conclusion: Based on our study, it appears that elderly patients with significantly displaced tibial plateau 
fractures (DTPFs) can be treated non-operatively as their primary management, despite the current consensus 
suggesting otherwise.
 Level of evidence: IV

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 11, Issue 4
April 2023
Pages 270-277

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History

  • Receive Date: 02 January 2022
  • Revise Date: 25 December 2022
  • Accept Date: 12 January 2023

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